Helmet ads miss the mark

The BPHC's helmet campaign depicts bloodied youth as a scare tactic.

Boston’s bike community will be the first to tell you that helmets are a good idea. Over the last few weeks, however, a large part of that community, including virtually all of its leaders, is up in arms over an advertisement that is meant to get more people wearing helmets.

Seem odd?

The ads are meant to scare people (they are meant to be targeted at young men in particular) into wearing a helmet, but it seems obvious to most observers that the ad will likely scare people away from bicycling altogether. And that would be bad, given that physical activity would really help out with the Mayor’s Million Pound Challenge—one of the city’s key prevention strategies this year. www.BostonMovesForHealth.org

The truth is that the Boston Public Health Commission—which paid around $50,000 for a month’s worth of bus stop posters depicting bloodied young cyclists—did ask for the Bike Union’s involvement on the campaign beginning back in May. The problem, however, is that they didn’t value our or other advocacy groups’ advice when we came to the table.

At that first meeting, the Union, MassBike, Livable Streets Alliance and others made it very clear to the various city agencies and health professionals in the room that the bike community would be open to just about anything but a scare campaign for the simple reason that we, thousands of Bostonians who support bike advocacy and volunteer in many ways, and the City of Boston itself have worked very hard to increase the cycling rate. We want to preserve those numbers, and get more people riding for the health benefits and other good things that it brings.

Given the clarity and unity on that message, the presentation at a second BPHC meeting on the proposed helmet ad campaign in August came as a shock. The worst fears, the things the advocacy community had specifically asked not to have, were there on the screen in bloody triplicate. Gasps filled the room. The Union asked if the ads had been tested to see if they might discourage biking. The BPHC responded that they had done focus groups and had asked that question. But when the Union requested and received the focus group results, it was clear that the question had not been addressed.

Instead, the “focus groups” actually comprised of only one focus group of a “men’s health” group, an online poll of 21 people (only one of whom did not wear a helmet), and three comments from “college/grad students.” The online poll participants suggested many positive ad ideas, the men’s health group asked for more shock value, and the “college/grad students” appeared to be studying health-related fields (thus having a clear bias).

These findings, to the Union’s leadership, did not seem like a thorough investigation of potential effects of a negative ad campaign. Moreover, it seemed at various times during our conversations with the BPHC, that increasing or at least maintaining the cycling rate was not one of the directives of this campaign. And if that was the case, why would one branch of government be allowed to run the risk of working against the work of another branch of government, in this case, Boston Bikes?

Additionally, it is not clear that focusing on the use of helmets has a significant effect on rider safety. A study of bicycle-related injury data from all nine Boston Emergency Rooms was projected at that first meeting about the helmet ads, and city officials, bike advocates and ER doctors in the room saw that only 2.2 percent of the 1,411 bike crash victims the ERs saw in 2010 had head injuries. Only a third of those people, 11 in total, had injuries serious enough to be admitted to the hospital after the ER. This number is dwarfed by hospitalizations for injuries of other kinds.

Another statistic from that meeting showed that 28 percent of bike crash victims in 2010 had fractures or dislocations, and over a quarter of those were admitted for a longer hospital visit (82 people). Overall, 58 percent of all hospital admissions (post-ER) for bike related incidents in 2010 were for fractures or dislocations, compared to 8 percent for head injuries. So why not focus on the prevention of the crashes in the first place?

The ER study is one of the only products of a BPHC investigation into bike and ped crash data that has now spanned two years, and it does not mention helmets as part of its conclusion. Instead it highlights the need for prevention through education and outreach, access to information on the “environmental context” of injuries (such as location and cause from police and ambulance data), and identifying crash hot spots.

All of this is in line with what the Bike Union has been recommending for the last three years: data-driven safety efforts. Better crash data, we believe, will help make the argument for better infrastructure and policies and inform strategies for prevention through targeted safety education and outreach.

For the $50,000 spent on this ad campaign, or a fraction of it, the city could have paid an expert to compile and redact private information from the police reports that tell us all about the cause of crashes. Then, that data could be matched with valuable ER information, allowing us to see how the most serious crashes are happening, and make all of the findings available to the transportation department, advocacy groups, and to the health department. This would allow the city to build better bike infrastructure in smarter ways, encourage targeted bike safety programming from other organizations, and maybe even some put out some ads that hit the target and actually make biking safer.

Point well made! Spending $50K of public money on a scare campaign against bicycling because of 11 serious head injury/year is ridiculous. In a country with over 2/3 of the population being overweight and a city chock-full of cars and traffic jams, discouraging biking shows very poor judgement from BPHC.

BPHC people, please read the studies: getting more people to ride bikes is what makes biking safer. Not scaring them of biking.

I think these postings require a little “creative editing” and commentary. I’ll be sure to do my share of that if I see them in my neighborhood.

I, unfortunately, believe that this article has missed the mark. As a cyclist who has been in an accident where a helmet most probably saved my life, I find the priorities of the BCU misguided. To argue that head injuries only constitute a small percentage of accidents ignores the reality that head injuries clearly have the potential to be more serious. Obviously fractures and dislocations happen with higher frequency, but a dislocation will not lead to brain damage or death. If this campaign caused some non-helmet wearing cyclist to cease riding, that would be sad but not as tragic as a life lost.

I’m really upset and frustrated about these ads. If they needed to spend the money on advertising, they would impact cyling safety much much more by aiming a campaign at drivers to educate them about dooring. There are plenty of other driver education issues, but I think dooring could have a clear, simple message and have a strong impact. Other cities do this sort of driver education, and have fewer crashes as a result. Just teaching drivers that they need to look before opening a door could easily save lives, when some of the worst fatalities we hear about are due to doorings.

I agree with the points in this piece. It is also infuriating to me that they would distract people from the real problem and potentially discourage biking in the city. In certain cases I’ve heard that helmets can make biking more difficult because drivers act differently around bikers wearing helmets versus those that do not. In European cities many people do wear helmets and the accident rates or head trauma injuries are not higher there than they are here. In another study, it was found that the health benefit obtained from the exercise while biking over a long enough period of time was greater than the benefit to health associated with wearing a helmet. Thus, there is even a debate about wearing helmets out there and further supports the BCU’s position here that this approach by BPHC is very strategic.

This situation echos what has happened in many cities (New York City in particular) over these scare tactic campaigns: Poor formative research leading to a campaign that really only works to anger the groups it needs to reach most. Not just with bike injuries, but with other health problems such as smoking, obesity, and HIV. Come on, Public Health! you can do better than this.

Isn’t the point however for marketing to raise awareness. Even if the ad “misses the mark”, their are people discussing it, which only brings more attention to the issue at hand. To me, I think that is kind of the point.